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Medical and Dental Questionnaire

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We take your health very seriously

It is vital for all patients attending The Gentle Dental to complete our secure and confidential Medical and Dental Questionnaire (MDQ) before their first appointment. It is designed to give us all of the information we require to provide you with the best care possible. This form will take around 10-15 minutes to complete and has been developed over many years of experience. Please do take the time to do it completely, every detail is important. You can start the form and return to it later to complete.

If you are a new patient to The Gentle Dental, please ensure that we receive your completed form at least 24 hours before your consultation so that we may prepare properly for your first visit.

If you are already a patient at The Gentle Dental, we will also update this form each time you attend the practice to ensure that we always have the up-to-date status of your current medical and dental health. Your data will be securely stored and this form will be editable in future without needing to be completed in full again.


Get in touch

“It feels like an absolute blessing to be able to chew food again ‘properly’. I am so thankful…

Mrs Charlton

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Fantastic Dentist, I haven't stopped recommending their care, skill and professionalism. The opening times and appointment availability is…

Georgie Sherrard

Dr Ali and his team created a Hollywood smile for me. I am absolutely thrilled. I had horrid…

Caroline Mitchell

I have been a patient of Dr Ali Rifai at The Gentle Dental Practice for a while now…

Jason Hamilton

I am completely delighted with the results of my Invisalign treatment. Thank you so much Ali for all…

Judith Pain

Dr Rifai and his staff have been looking after my mother for several years, she's in her 90s…

Paul Bennett

I had a tooth filling with Ali at The Gentle Dental Practice recently. The finished filling is amazing…

Joshua Beth

I have recently been coming here to have work on my teeth and I’ve enjoyed every moment of…

Kane Sharman

What an amazing dental practice. Everyone is so friendly and helpful. Dr Ali is great and understanding. I…

Ria Winstanley

Ali is an excellent dentist. He also cares very much for patient well being. Ali also went beyond…

lisa clark

Did a great job of straightening my teeth with invisalign treatment!

James Crisp

Amazing service! You can have a crown made whilst you wait, and no more horrible moulds!! Highly recommend…

Domenica Dilieto

I visited The practice for the first time yesterday and had emergency dental treatment. Ali was absolutely brilliant…

Emma King

I am delighted to be able to offer my thoughts regarding the dental work offered by Dr Rifai.…

Paul Stratton

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